Application for Renewal Of Registration   with the
Maharashtra Medical Council, Mumbai
Application No :  MMC202167678 Date : 28/12/2021
To,
Registrar ,
Maharashtra Medical Council ,
189/A, Anand Complex, 2nd Floor,
Sane Guruji Marg, Arthur Road Naka,
Chinchpokali (W), Mumbai - 400 011.
 
Sub: Dr  (Smt/Shri)  KALE CHANDRASHEKHAR BHALCHANDRA
Registration No:  2002093380   Registration Date : 16/09/2002   Valid upto Date :28/02/2027
Sir,
I the undersigned applicant, request yoy that my name may be continued on the Register of Medical Practitioners maintained by the Maharashtra Medical Council as per 23 (a)/23 (c) of MMC Act 1965 and amendment 2003. My particulars are as Follows :
Name of Applicant : Mr. KALE CHANDRASHEKHAR BHALCHANDRA
Name of Father : Mr.
Name of Mother : Mrs.
In Case of Married Women
Maiden Name : -

RESEDENTIAL ADDRESS : 11/601, MANDAR, VASANT VIHAR , POKHRAN ROAD NO 2 , THANE
City : THANE District : THANE
State : MAHARASHTRA Country : INDIA
Pincode : 400610
Date of birth : 10/03/1978 Tel No (Res) : Clinic No :
Mobile No : 9320426222 Email Id : drshekharkale@rediffmail.com  
Total Obtained Credits Points : 36
Remaining Credits Points : 0
Qualification Details
 Details of QualificationName of CollegeUniversityPassing YearCertificate NoCertificate Date
1.M.B.B.S.LTMC MUMBAIMUMBAI UNIVERSITY2002  
2.M.S. (Ophthalmology)K.E.M MUMBAIMUMBAI UNIVERSITY20072842912/07/2007
Pariticulars Of Payment
Payment Mode : Online Payment
Receipt No : 202136295255506
Receipt Date : 29/12/2021
   I have uploaded following documents:
1.Latest Passport size Photograph
DECLARATION (Registered Medical Practitioner)
I shall abide by the Code of medical Ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.
Date : 28/12/2021
    Applicant signature               


NOTE:- You do not need to submit the print out of original submitted Renewal Application form to MMC office.